Jason Aaron Sokol, MD

Lower Blepharoplasty

Lower Eyelid Blepharoplasty

As we grow older, our bodies undergo a number of visible changes. One of the most noticeable changes is the ‘ageing eyes’ that is characterized by changes in the upper eyelids and lower eyelids.

The lower eyelids are plagued by three main aesthetic problems, namely festoons of the orbicularis oculi muscle, malar mounds and protruding intraorbital fat which are effectively managed by a lower eyelid blepharoplasty.

Defining Problems of the Lower Eyelid

Festoons of the eyelids are redundant folds of lax skin and orbicularis muscle of the upper or lower eyelids that hang, in hammock-like fashion, from canthus to canthus when the face is upright. Festoons may possibly be in the upper eyelid, pretarsal or lower eyelid, orbital, malar or cutaneous dewlap with no muscle.

Malar mounds are discrete, pillow-like, soft tissue bulges that protrude from the lateral part of the malar eminence. They are inconspicuous during normal facial expressions but may possibly be accentuated by smiling.

Palpebral bags or baggy eyelids are may also be called herniated intraorbital fat. They are the result of intraorbital fat bulging outward against an attenuated or weak orbital septum of the upper or lower eyelid. They are the most common aesthetic deficiency of the eyelids.

Indications of Lower Eyelid Blepharoplasty

A lower eyelid blepharoplasty is considered appropriate management for palpebral or malar festoons, mounds, or bags that reflect an appreciable aesthetic defect in an otherwise physically and psychologically healthy patient. When perfectly executed, it is highly rewarding for both the surgeon and the patient.

Absolute Contraindications: Any pathologic condition of the eyelids or orbital structures is an absolute contraindication for blepharoplasty. This may possibly however be relaxed if agreed upon by both the patient and the surgeon.

Relative Contraindications: Any medical conditions that may possibly alter the patient’s response to anaesthesia or sedation or a patient with unrealistic expectations.

Lower Eyelid Blepharoplasty – The Procedure

A blepharoplasty usually requires about 1 to 3 hours and may possibly be done under local anaesthesia or under general anaesthesia.

A lower eyelid blepharoplasty involves the following steps:

Step 1. Local Anaesthesia: The procedure is done under local or modified local anaesthesia and patient co-operation is of utmost importance in achieving a symmetrical surgical outcome.

Step 2. Making the Skin Incision: Incision lines are made below the lower eyelashes in a discreet manner such that the incision is hidden from plain view.

Step 3. Skin Excision: The skin overlying festoons, malar mounds and baggy eyelids may possibly or may possibly not be removed depending on the outcome desired.

Step 4. Fat Removal and Redistribution: Excess fat is removed or redistributed to obtain a smooth and younger-looking surface above the cheek and under the eyes. When present, muscle laxity is also corrected during this step. Fat may possibly also be transferred or dermal fillers applied to hollow areas for a plump, healthy looking face to correct sunken eyes.

Step 5. Haemostasis: Bleeding is less of a problem with lower eyelid blepharoplasty but must be tackled instantaneously if it occurs.

Step 7. Closure: The wound is closed using either absorbable or non-absorbable sutures. Sutures should be removed at 7 to 8 days following surgery. The wound heals with scars blending with the surrounding natural creases.

What can you expect from a Lower Eyelid Blepharoplasty?

Lower eyelid blepharoplasty removes festoons, malar mounds and baggy eyelids thus providing a highly improved, younger-looking eyes that is immensely gratifying for both the patient and the surgeon. The contrasting looks in the pre-surgery and post-surgery photos is quite dramatic with well sculpted lines and creases with obvious absence of baggy eyelids, festoons and malar mounds.

The effects of blepharoplasty usually last 5 to 7 years, but may possibly even provide lasting effects for decades. It is best to be optimistic yet set realistic end-points before undergoing the surgery for best results.

However, keep in mind the recovery period immediately after surgery during which there is swelling, pain, redness and irregularity of surface. These changes are transient and will resolve to form a smooth, glowing and accentuated surface that is free of irregularities.

Blepharoplasty can be both a functional and cosmetic surgical procedure intended to reshape the upper eyelid or lower eyelid by the removal or repositioning of excess tissue as well as by reinforcement of surrounding muscles and tendons.

Eyelid surgery to improve the appearance of the eyelids is often called 'eyelift' or 'blepharoplasty'.

As we age, your eyelids (both upper and lower) may possibly become 'droopy' or 'baggy'. The eyelid skin stretches and muscle tone weakens

In addition, your eyebrows may possibly also droop.

Your droopy upper eyelids and droopy brows may possibly give you the appearance of being sleepy, tired and aging prematurely

In addition, this sagging, may possibly lead to brow/eyelid strain

Excess skin can hang over the eyelid and interfere with vision

This surgery can be performed on both the UPPER and on the LOWER eyelids - or both.

Patients with a less severe amount of excess skin may possibly have a similar procedure performed for cosmetic reasons.

Lower eyelid blepharoplasty is almost always done for cosmetic reasons, to improve puffy lower eyelid "bags" and reduce the wrinkling of skin.

Blepharoplasty is performed through external incisions made along the natural skin lines of the eyelids, such as the creases of the upper lids and below the lashes of the lower lids, or from the inside surface of the lower eyelid. Initial swelling and bruising take one to two weeks to resolve but at least several months are needed until the final result becomes stable.

Depending upon the scope of the procedure, the operation takes one to three hours to complete.